Abstract:

Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis. Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023. Five patients were diagnosed and treated before 2020， while 47 were managed from 2020 onward. Patients were divided into two groups： a local debridement group （n = 28） and an en bloc osteotomy group （n = 24）. Perioperative outcomes—including operative time， incision length， intraoperative blood loss， and length of hospital stay—were assessed， along with clinical efficacy at 6 months， 12 months， and final follow-up. Clinical outcomes were evaluated using the Hospital for Special Surgery （HSS） knee score， the American Orthopaedic Foot & Ankle Society （AOFAS） ankle-hindfoot score， joint range of motion （knee flexion-extension and ankle plantarflexion-dorsiflexion）， recurrence rate， and the Paley classification for infectious bone defects. Results The local debridement group exhibited significantly less intraoperative blood loss （P < 0.05）， shorter operative time （P < 0.05）， and reduced hospital stay （P < 0.05）， as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively （P < 0.05）. In contrast， the osteotomy group demonstrated superior Paley classification outcomes at 6 months， 12 months， and final follow-up （P < 0.05）， along with lower rates of infection recurrence. Longitudinal analysis indicated significant improvements in AOFAS scores， HSS scores， and joint mobility over time in both groups （P < 0.05）. However， no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up （P > 0.05）. Conclusion En bloc osteotomy combined with the induced membrane technique （Masquelet technique） enables more comprehensive debridement， minimizes the necessity for repeated surgical interventions， reduces postoperative complications， lowers the risk of recurrence， and promotes enhanced bone healing.

Key words: chronic osteomyelitis, membrane induction technique, en bloc osteotomy, focal debridement, observational study